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GPs hit out at retail surgery plans

The debate over the role of the private sector in primary care went into overdrive after the Government’s announcement last week that retail giants such as Virgin, Boots and Tesco could provide the answers to GP access.

By Gareth Iacobucci

The debate over the role of the private sector in primary care went into overdrive after the Government's announcement last week that retail giants such as Virgin, Boots and Tesco could provide the answers to GP access.

News that talks were to be held with these and other companies about what could turn into a massive upscaling of the role of APMS services had the added ingredient of coming at a time when GPs found themselves uniquely under attack from private sector chiefs.

On the same day that health secretary Alan Johnson spoke of his desire to get more GP services into ‘underdoctored areas' and the Department of Health said it would listen to all proposals from the private sector, the CBI condemned GP opening hours. It called for more target setting, an expansion of private providers and dual patient registration and surgeries closer to the workplace – be that in pharmacies, gyms or supermarkets.

With the CBI's report – which was embraced by Mr Johnson – being launched at Boots' flagship store in the West End, GPs could have been forgiven for thinking big business was about to take over primary care altogether.

The prospect of Virgin, Tesco, Asda or Sainsbury's becoming APMS employers of salaried GPs is, however, a world away from today's involvement by the retail sector in the provision of primary care.

The example used by Boots, of a pilot surgery – not in Oxford Street but at its store in Poole, Dorset – does not even have extended hours, opening 9am to 5pm Monday to Friday as a branch, GMS-run surgery.

Indeed, Dr Mark Nelms, a GP in Poole who works at the surgery, says the scheme has been successful because it is ‘very clearly NHS provision', and operated ‘like a branch surgery rather than a walk-in-centre' (see box).

However, with the Department of Health seemingly courting all comers from the retail sector and at the same time sending access hit squads into PCT areas that it says are failing to provide good enough access to GPs, how long before PCTs start becoming more ambitious in their APMS ambitions?

Dr Lionel Cartwright, joint interim PEC chair of Bournemouth and Poole PCT, says the financial model used at the pilot surgery in Poole – where the PCT rents space for an NHS-run GP service within a Boots store – could be used again. But he refused to rule out the possibility of offering APMS contracts to providers such as Boots in the future.

He said: ‘We have an open mind, and are willing to consider any options, but the key determinant would be how it will affect patients.'

The pressure is on

Boots managing director Alex Gourlay confirmed last week that the company had recently had 30 enquiries to set up similar surgeries elsewhere from ‘a combination of PCT enquiry and GP practices'.

He insists Boots is ‘keen that ownership remains with the GP' but says it wants ‘to make healthcare more convenient'.

Boots has spoken openly about a huge amount of GP workload being able to be handled by pharmacists, which explains its interest.

As far as PCTs are concerned, the pressure is bound to increase, particularly on those trusts where the Government says access is not up to scratch.

Barking & Dagenham and Oldham PCTs – two of those singled out by the health secretary as being underdoctored – say they are prepared to discuss service provision with a range of private providers, which under Government plans could involve the retail chains.

Whether the latest APMS idea becomes a much wider, nationwide drive outside areas with particular problems recruiting and retaining GPs is up for debate.

Dr Anita Sharma, a GP in Oldham, Lancashire, and member of the Small Practices Association, says that PCTs should talk to GPs before rolling out one-stop satellite surgeries in high-street shops.

‘I will be concerned if the PCT is looking at private providers – they should talk to GPs who work in this area first.

‘As a GP, I know my patients, I know when they have a genuine problem and an outside person may not be able to make that decision,' she adds.

‘We provide a good quality service, and whether outside providers can match that I doubt very much.

‘Continuity is a worry. We know the locality needs. I have no objection to them dealing with short-term, acute illnesses, but for chronic illnesses, you need one provider.'

Dr Tushar Ghosh, a GP in Dagenham, Essex, agrees that continuity of care could be lost with the increased role of private providers, and says family doctors are ‘fundamental to the British model of continuity of care'.

However, he admits GPs will have to meet the competition from private providers by being ‘proactive, not reactive'.

‘We have to sell our practices and make them more attractive to the public,' he says.

‘If someone opens a shop next door, we have to be better, and work in conjunction with other local practices to improve services. Maybe the style has to change, but the concept of family doctors isn't going to change.'

With Lord Ara Darzi's talks imminent, the debate over the role of private providers in primary care looks set to rage on.

Although few would argue that GP services in some areas are stretched, the manner in which existing services are supplemented is a fiercely divisive issue, and is likely to create further debate over the future direction of the NHS.

Why retailers as GPs won't work

Dr Mark Nelms, a GP at the Boots surgery in Poole, Dorset, says the pilot branch – hailed by ministers as an example of how the private sector can be used to improve GP access – has indeed improved access.
But the surgery is a far cry from the APMS model favoured by the Government.
It operates as a branch of a GMS surgery with normal opening hours, which Dr Nelms says offers ‘greater capacity to see patients'.
He says this was previously hindered by a shortage of rooms and an expanding population.
He adds: ‘Personally, I think this should be a partnership, with very clear divisions between NHS provision, where the partner like a landlord.
‘I would be anxious about any plans where Virgin or whoever employed and became the GP, because the public would perceive that as a privatised scheme.'

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